老年胸腰段骨质疏松性椎体压缩骨折合并腰椎退变性滑脱对脊柱‑骨盆矢状位参数的影响

Effect of thoracolumbar osteoporotic vertebral compression fracture combined with lumbar degenerative spondylolisthesis on spinopelvic sagittal parameters in elderly patients

目的探讨老年胸腰段骨质疏松性椎体压缩骨折(OVCF)合并腰椎退变性滑脱(LDS)对脊柱‑骨盆矢状位参数的影响。方法采用病例对照研究分析2016年12月至2021年12月上海交通大学附属第一人医院收治的77例胸腰段OVCF患者的临床资料,其中男16例,女61例;年龄61~92岁[(73.9±8.4)岁]。均为单节段胸腰椎(T 11~L 2)骨折。单纯胸腰段OVCF 49例(OVCF组),胸腰段OVCF合并LDS 28例(OVCF+LDS组)。术前测量并比较两组骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、腰椎前凸角(LL)、胸椎后凸角(TK)、胸腰椎后凸角(TLK)、矢状面轴向距离(SVA)及Roussouly分型分布。结果两组PT、SVA差异无统计学意义(P均>0.05)。OVCF+LDS组PI、SS、LL、TK和TLK分别为(55.8±11.0)°、(34.1±10.9)°、(45.7±9.1)°、(35.7±6.1)°和(24.8±5.2)°,显著大于OVCF组的(47.9±8.8)°、(27.0±9.4)°、(33.1±7.9)°、(29.5±6.2)°、(18.4±5.5)°(P均<0.01)。Roussouly分型Ⅰ~Ⅳ型的例数OVCF组分别为22例、16例、5例、6例;OVCF+LDS组分别为8例、5例、6例、9例(P<0.05)。结论老年胸腰段OVCF合并LDS可明显改变脊柱‑骨盆矢状位参数,LDS可能加重胸腰段OVCF后凸畸形,应尽早手术矫正,防止矢状位失平衡。

Objective To investigate the effect of thoracolumbar osteoporotic vertebral compression fracture(OVCF)combined with lumbar degenerative spondylolisthesis(LDS)on spinopelvic sagittal parameters in the elderly.Methods A case‑control study was conducted to analyze the clinical data of 77 patients with thoracolumbar OVCF admitted to Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine from December 2016 to December 2021.There were 16 males and 61 females with the age of 61‑92 years[(73.9±8.4)years].All patients had single‑level thoracolumbar fractures(T 11‑L 2).Simple thoracolumbar OVCF was found in 49 patients(OVCF group)and thoracolumbar OVCF combined with LDS in 28(OVCF+LDS group).The pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL),thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),sagittal vertical axis(SVA)and Roussouly types were detected and compared between the two groups before operation.Results There was no significant difference in PT and SVA between the two groups(all P>0.05).The PI,SS,LL,TK and TLK in OVCF+LDS group were(55.8±11.0)°,(34.1±10.9)°,(45.7±9.1)°,(35.7±6.1)°and(24.8±5.2)°,significantly larger than(47.9±8.8)°,(27.0±9.4)°,(33.1±7.9)°,(29.5±6.2)°and(18.4±5.5)°in OVCF group(all P<0.01).Roussouly types I‑IV counted 22,16,5 and 6 patients in OVCF group,compared to 8,5,6 and 9 patients in OVCF+LDS group(P<0.05).Conclusions Elderly patients with thoracolumbar OVCF combined with LDS can significantly alter spinopelvic sagittal parameters,and LDS may aggravate the thoracolumbar kyphosis of OVCF.To avoid sagittal imbalance,surgery should be performed as soon as possible.